Red Cell Distribution Width-to-High-Density Lipoprotein Cholesterol Ratio (RHR): A Promising Novel Predictor for Preoperative Deep Vein Thrombosis in Geriatric Patients with Hip Fracture

Abstract

Background

Deep vein thrombosis (DVT) is a devastating complication in geriatric patients before hip fracture surgery, and the predictive value of red cell distribution width (RDW) and high-density lipoprotein cholesterol (HDL-C) for DVTs after hip fracture remains to be established. This study aimed to assess the predictive value of RDW, HDL-C, and RDW-to-HDL-C ratio (RHR) in preoperative DVTs screening.

Methods

We retrospectively analyzed the data of geriatric patients (≥65 years old) admitted for hip fracture surgery between 2015 and 2020. The receiver operating characteristic (ROC) curve and related parameters were used to evaluate the predictive value of the biomarkers. Patients were divided into two groups according to the cutoff value of RHR, and propensity score matching (PSM) and subgroup analyses were performed to assess the true correlations between RHR and DVT.

Results

Among 2566 eligible patients included, we identified RDW with the area under ROC curve (AUC) of 0.532, cut-off value of 15.89, specificity of 88.2%, sensitivity of 18.2%, HDL-C with AUC of 0.574, cut-off value of 1.20, specificity of 55.6%, sensitivity of 59.3%, and RHR with AUC of 0.578, cut-off value of 13.45, specificity of 71.3%, sensitivity of 43.4%. RHR (>13.45) was independently associated with 1.54-fold risk (95% CI: 1.11–2.14, P=0.011) of DVTs among the post-PSM cohort. And compared with the counterparts, the relative risk of RHR associated with DVT was higher in the subgroups of aged 65–79 years (1.61 vs 1.45), non-hypoproteinemia (2.70 vs 1.29), non-diabetic (1.58 vs 1.41), non-hypertension (2.40 vs 1.06), ASA score I-II (2.38 vs 1.04), and femoral neck fracture (1.70 vs 1.50).

Conclusion

RDW, HDL-C and RHR were valuable biomarkers in predicting preoperative DVTs in geriatric patients with hip fracture, and RHR would be more efficient in the subgroups of younger age, better medical condition or femoral neck fracture.

Keywords:

• geriatric patients
• hip fracture
• deep vein thrombosis
• red cell distribution width
• high-density lipoprotein cholesterol

Abbreviations

DVT, deep vein thrombosis; PE, pulmonary embolism; VTE, venous thrombus embolism; SSIOS, Surgical Site Infection in Orthopaedic Surgery; STROCSS, Strengthening the Reporting of Cohort Studies in Surgery; DUS, duplex ultrasonography; ROC, receiver operating characteristic; AUC, area under the curve; PPV, positive predictive value; NPV, negative predictive value; PSM, propensity score matching; IQR, interquartile range; RR, relative risk; CI, confidence interval; RDW, red cell distribution width; HDL-C, high-density lipoprotein cholesterol; RHR, red cell distribution width-to-high-density lipoprotein cholesterol ratio; BMI, body mass index; ASA, American Society of Anesthesiologists; HGB, hemoglobin, reference range: Females, 110–150g/L; males, 120–160g/L; PLT, platelet; ALB, albumin; FBG, fasting blood glucose; AT III, antithrombin III; PT, prothrombin time; APTT, activated partial thromboplastin time; FIB, fibrinogen; HCRP, high-sensitivity C-reactive protein; RBCs, red blood cells; TFPI, tissue factor pathway inhibitor; ROS, reactive oxygen species; TF, tissue factor; NO, nitric oxide.

Data Sharing Statement

All the data used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Ethics Approval and Consent to Participate

This study was approved by the ethics committee of The Third Hospital of Hebei Medical University, and the informed consent was waived for its retrospective nature. All the data were analyzed anonymously to safeguard patient privacy.

Consent for Publication

We have obtained the consent for publication from all participants.

Acknowledgments

The Key Laboratory of Biomechanics of Hebei Province provided the site for querying data. Xiang Lei and Haifeng Wu approved the final version of the manuscript.

Author Contributions

Xinqun Cheng and Lingjia Fan are considered first co-authors. All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; agreed to submit to the current journal; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.

Disclosure

All the authors declare that they do not have a conflict of interest

Additional information

Funding

The authors have received no external funding in order to support this project.